Trends in Frailty and Use of Evidence-Based Pharmacotherapy for Heart Failure in Australian Hospitalised Patients: An Observational Study

Frailty increases morbidity and mortality in heart failure (HF) patients. Current risk-adjustment models do not include frailty-status and the relationship between frailty and pharmacotherapy is unclear. This study explored trends in frailty over time and its relationship with prescription of heart failure specific pharmacotherapy in hospitalised HF patients. We used the Hospital Frailty Risk Score (HFRS) to determine frailty status of patients ≥18 years admitted between 2015–2019 at two tertiary hospitals in Australia. Patients with an HFRS ≥ 5 were classified as frail. In the 3706 patients with a mean (SD) age of 76.1 (14.4) years, 876 (23.6%) were classified as frail. HFRS was weakly correlated with age (r = 0.16) and Charlson-index (r = 0.35) (both p values < 0.001). Whilst frailty was more common in older HF patients (28.9% of patients ≥80 years), 15.1% of patients ≤65 years of age were also found to be frail. The proportion of frail patients increased from 19.4% in 2015 to 29.2% in 2019 despite no significant change in age during this period. The proportion of patients who received heart failure specific pharmacotherapy decreased from 86.7% in 2015 to 82.9% in 2019 (p value = 0.03) and frail patients were significantly less likely to be prescribed HF specific pharmacotherapy than non-frail patients (77.4% vs. 85.9%, p < 0.001).

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Prognostic Value of Cardiac Troponin I In Infective Endocarditis

European Heart Journal Supplements ◽

10.1093/eurheartj/suab069.011 ◽

2021 ◽

Vol 23 (Supplement_D) ◽

Author(s):

Salma M Thabet ◽

Marwa Meshaal ◽

Yasser Yazied ◽

Yasser Sharaf

Keyword(s):

Heart Failure ◽

Infective Endocarditis ◽

Cardiac Troponin ◽

Prognostic Value ◽

Troponin I ◽

Cardiac Troponin I ◽

P Value ◽

Significant Relation ◽

P Values ◽

Septic Pulmonary Embolism

Abstract Aim The aim of this study is to assess the prognostic value of cardiac troponin I as a predictor of in-hospital morbidity and mortality in patients with infective endocarditis. Methods This study included 48 patients with definite and possible IE according to modified Duke’s criteria for diagnosis of IE. This prospective longitudinal study was conducted on patients admitted to the cardiovascular department of Cairo University hospitals. All patients were subjected to full history taking and clinical examination, all laboratory and radiological investigations which included chest radiography, echocardiogram and other diagnostic procedures as needed for diagnosis and follow-up of IE were done with emphasis on cardiac troponin I level on admission. Results Troponin I was found to be statistically significant predictor for heart failure (NYHA III/IV), septic pulmonary embolism and in-hospital mortality in infective endocarditis patients by univariate and multivariate regression analysis with P values 0.023, 0.037and 0.002 respectively. Tricuspid valve vegetations had showed significant relation to troponin I levels with p value 0.033. Also it was found that SOFA score on first day of admission showed significant relation to troponin I level with P value 0.045 and 0.004 for prediction of hospital stay duration. Shock and intracranial hemorrhage showed borderline significance with P values 0.097, 0.069. On other hand, troponin I as predictor of pulmonary edema, mechanical complications, systemic embolization, acute kidney injury and presence of aortic root abscess had no statistical significance in our studied patients. Conclusions This study showed that there is as significant predictive value of elevated cardiac troponin I with heart failure, septic pulmonary embolism and all cause in-hospital mortality. In addition, it was significant predictor of the length of hospital stay, lymphocytosis and SOFA score. These results are emphasizing that cTn I level may predict higher risk patients who would need early and aggressive control of infection medically alone or combined with surgery in IE patients.

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Heteroskedasticity between GNSS time-series repeatabilities and noise magnitudes

10.5194/egusphere-egu21-4702 ◽

2021 ◽

Author(s):

Huseyin Duman ◽

Doğan Uğur Şanlı

Keyword(s):

Time Series ◽

Linear Equations ◽

Test Methods ◽

P Value ◽

P Values ◽

Modeling Errors ◽

Alternative Hypotheses ◽

The Relationship ◽

Baseline Component ◽

Gnss Time Series

In the analysis of GNSS time series, when the sampling frequency and time-series lengths are almost identical, it is possible to highlight a linear relationship between the series repeatabilities (i.e. WRMS) and noise magnitudes. In the literature, linear equations as a function of WRMSs allowed many researchers to estimate the noise magnitudes. However, this was built upon homoskedasticity. We experienced the higher WRMSs, the more erroneous analysis results using the noise magnitudes from the linear equations stated. We hence studied whether or not homoscedasticity clearly describes the modeling errors. To test that, we used the published results of GPS baseline components from the previous work in the literature and realized here that each component forms part of the totality. We introduced all baseline component results as a whole into statistical analysis to check heteroskedasticity. We established null and alternative hypotheses on the residuals which are homoscedastic (H0) or heteroskedastic (HA). We adopted both the Breusch-Pagan test and the Goldfeld-Quandt test to prove heteroskedasticity and obtained p-values for both methods. The p-value, which is the probability measure, equals to almost zero for both test methods, that is, we fail to accept the null hypothesis. Consequently, we can confidently state that the relationship between the WRMSs and the noise magnitudes is heteroskedastic.Keywords: Noise magnitudes, repeatabilities, heteroskedasticity, time-series analysis

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CLINICAL CHARACTERISTICS OF FRAILTY IN JAPANESE RHEUMATOID ARTHRITIS PATIENTS

Journal of Frailty & Aging ◽

10.14283/jfa.2020.1 ◽

2020 ◽

pp. 1-6

Author(s):

I. Yoshii ◽

M. Kondo

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Clinical Characteristics ◽

Short Term Memory ◽

Common Symptom ◽

Frailty Status ◽

Joint Deformity ◽

Frail Patients ◽

Rheumatoid Arthritis Disease ◽

The Relationship

Objective: The relationship between clinical characteristics and frailty was investigated in rheumatoid arthritis (RA) patients >40 years old. Methods: RA patients followed for >1 year were interviewed and diagnosed as frail according to a 5-item frailty score index: (1) weight loss >2 kg within 6 months (WL); (2) slower gait speed (GS); (3) exercise less than once per week (EX); (4) decline in short-term memory (SM); and (5) general fatigue in the past 2 weeks (GF). The relationship between frailty status and background parameters was evaluated. Results: Among 739 subjects, frail patients comprised 221, pre-frail patients comprised 203, and robust comprised 315. The most common symptom in the Frailty group was GS, followed by SM, GF, EX, and WL, whereas the most common symptom in the Pre-frailty group was GS followed by SM, GF, WL, and EX. Frailty was significantly correlated with aging. Elderly onset rheumatoid arthritis, disease activity, serum C-reactive protein concentration, degree of joint deformity, activities in daily living (ADL), dementia treated, and glucocorticoid steroid administration demonstrated significant correlations with frailty status, although all factors also demonstrated significant correlation with aging. In addition, the EuroQol score (EQ5D) was significantly correlated with both aging and frailty. Conclusion: The results suggest that a remission state for disease activity, ADL, and dementia is correlated with frailty. The most common and primary symptom is GS. Elderly RA patients require careful attention for symptoms of frailty, which may damage the EQ5D score, specifically, the quality of life for RA patients.

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Echocardiographic Hemodynamic Heterogeneity of Advanced Heart Failure Patients as Compared to Patients with „Pre-Heart Failure”

Romanian Journal of Cardiology ◽

10.47803/rjc.2021.31.2.351 ◽

2021 ◽

Vol 31 (2) ◽

pp. 351-359

Author(s):

Elena-Laura ANTOHI ◽

Oliviana GEAVLETE ◽

Razvan RADU ◽

Ovidiu CHIONCEL ◽

Serban MIHAILEANU

Keyword(s):

Heart Failure ◽

Advanced Heart Failure ◽

Evidence Based ◽

Control Cohort ◽

Arterial Elastance ◽

Compensatory Response ◽

P Values ◽

Cardiac Power ◽

Lv Dysfunction ◽

Asymptomatic Patients

Background: Advanced heart failure (HF) represents a clinical entity encompassing severely symptomatic HF with severely dysfunctional left ventricles (LV). The single most important parameter for defining severe LV dysfunction and indicating the prescription of evidence-based therapies is LV ejection fraction (EF). We sought to investigate the hemodynamics by echocardiography in a cohort of advanced HF patients during a hospitalization for HF decompensation and assess the relevant differences when compared to a control cohort of asymptomatic patients with minor structural/functional cardiac abnormalities. Methods and results: In this prospective study we selected 18 advanced HF patients and 12 asymptomatic preHF patients with only minor structural/functional abnormalities. The 2 groups were clearly delineated by size parameters (end -systolic and -diastolic diameters and volumes respectively, with very low p values p<0.0001). Hemodynamic parameters were signifi cantly different as well in the advanced HF group vs the ‘pre-HF’ group, including: ventricular-arterial coupling 1.745 vs. 0.895, p=0.0007; cardiac power output 0.762 vs. 0.932, p=0.044, systolic times ratio 0.406 vs. 0.200, p=0.0001. There were no significant differences for neither effective arterial elastance (Ea) and nor for cardiac index. Inside the advanced HF group, no correlation between LVEF and other parameters were found and none of these parameters could predict outcome. We observed a highly skewed variation of Ea in advanced HF patients. Conclusion: Among the most severe HF patients, the hemodynamic interaction between the dysfunctional LV and the compensatory response of the peripheral system is heterogenous and cannot predict outcome by single parameters. In these patients, assessment of cardiac performance should no longer rely on LEVF alone.

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Evidence-Based Practice Awareness And Knowledge levels Among Health Care Practitioners in Saudi Tertiary Hospitals (Preprint)

10.2196/preprints.13185 ◽

2018 ◽

Author(s):

Deena Barakah

Keyword(s):

Health Care ◽

Health Care Providers ◽

Evidence Based Practice ◽

Absolute Risk ◽

P Value ◽

Evidence Based ◽

Care Providers ◽

Medical City ◽

Tertiary Hospitals ◽

Knowledge Levels

UNSTRUCTURED Estimating the awareness levels of Evidence-Based Practice (EBP) among health care providers is currently active area of research. This study main objective is to evaluate the medical staff awareness about Evidence-Based Practice and its constitutes , tools and resources at Saudi General Tertiary Hospitals. The study was carried out at King Saud Medical City (KSMC) in Riyadh, Saudi Arabia. The research main data were collected predominantly using a cross-sectional survey questionnaire. The research results showed that showed that majority of participants have a good understanding of the term EBP (59.7%) ,while having a vague idea (34.7%) and with No idea are only (5.6%). Although of a high percentage of the participants realize the concept of EBP , levels of knowledge about various EBP tools vary considerably The less known EBP tools were for: Confidence interval (34.2%) , and P- value tool , Odd ratio ,and Heterogeneity (31.9) followed by Absolute Risk (29.8 %) and Sensitivity tool (27.7%). Among the most known EBP tools with “Good Understanding” level were for: Meta Analysis (27.7%) followed by Systematic review and Publication Bias both at 25.3%) level . The Chi-Square tests for the correlation of specialty rank and awareness of EBP indicates that there is no statistically significant association between Profession specialty rank or gender with EBP awareness or its tool knowledge levels . Main results from this research showed that Evidence-Based Practice awareness at King Saud medical city hospitals is at acceptable level. Furthermore, more intensive education and training and enhancement of EBP resources IT medical education resources are needed to increase its knowledge and understanding , and to support the diffusion of Evidence-Based Practice in daily practice.

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Abstract P025: Associations of Fetuin-A with Incident Heart Failure in Participants with and without Diabetes and Insulin Resistance: The Cardiovascular Health Study

Circulation ◽

10.1161/circ.129.suppl_1.p025 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Nketi I Forbang ◽

Traci M Bartz ◽

Kenneth J Mukamal ◽

Luc Djousse ◽

Jorge R Kizer ◽

...

Keyword(s):

Heart Failure ◽

Insulin Resistance ◽

Community Dwelling ◽

Health Study ◽

Arterial Calcification ◽

Cardiovascular Health Study ◽

P Value ◽

Fetuin A ◽

Diabetes Status ◽

The Relationship

Background: In animal models, the hepatic secretory protein fetuin-A simultaneously inhibits arterial calcification and causes insulin resistance. Increased calcification and insulin resistance lead to arterial stiffness, an important risk factor for heart failure (HF). The relationship between serum fetuin-A concentrations and HF, and whether it is modified by diabetes or insulin resistance has not been extensively studied. Research Design, Methods, and Objectives: In a prospective study of 4182 community-dwelling participants aged ≥ 65 years, Cox proportional hazards models were used to determine the association of fetuin-A (measured in 1992) with incident HF (followed up through June 2008). Multiplicative interaction terms determined whether diabetes or insulin resistance status modified the association. Results: Mean age was 75 ∓ 5 years, fetuin-A levels were 0.47 ∓ 0.10 g/L, and 1,186 incident HF events occurred during follow-up. In multivariable models adjusting for demographics and CVD risk factors, fetuin-A was not significantly associated with incident HF [HR per SD fetuin-A: 0.97, 95% CI (0.91, 1.04), p-value=0.40] and was not modified by prevalent diabetes status (p-interaction=0.54). However, when prevalent insulin resistant status was defined as previously by the presence of diabetes, or HOMA IR > median (2.22), or obesity (body mass index, kg/m 2 > 30), a significant interaction was observed (p-interaction=0.03). In 1,679 participants with no evidence of insulin resistance by the definition, each SD greater fetuin-A level was associated with a 12% lower risk of HF (95% CI: 2-22%) in a fully adjusted model (Table 1). Conclusions: Future studies should consider the presence of insulin resistance when evaluating the relationship between serum fetuin-A with adverse health outcomes.

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A single centre study assessing the effectiveness of active monitoring, using telemedicine, in preventing heart failure admissions and death in a primary care population with systolic heart failure.

10.21203/rs.3.rs-24702/v1 ◽

2020 ◽

Author(s):

Nicola Bowers ◽

Ben Lodge ◽

Charlie Clifford ◽

Ricardo Pio Monti ◽

Marc Phippen ◽

...

Keyword(s):

Heart Failure ◽

Primary Care ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Heart Failure ◽

Left Ventricular ◽

Active Group ◽

Control Group ◽

P Value ◽

Evidence Based ◽

Significant Difference

Abstract BackgroundPatients with systolic heart failure are at high risk of admission to hospital and death. This can be reduced by ensuring that they are receiving all evidence-based heart failure medications and by detecting early signs of deterioration in their condition.MethodsWe recruited 209 primary care patients with echocardiographically proven left ventricular systolic dysfunction (ejection fraction < 40%). 84 patients consented to be actively monitored by the heart failure team using telemedicine. 125 patients consented to receiving usual care but allowing access to their medical records. The primary end-point was cardiovascular death or admission to hospital for heart failure at 1 year. Secondary end-points included the prescription of evidence-based heart failure medications and patient satisfaction at the end of the study.ResultsThere was no difference in the mortality rate between the groups (6.02% in the active group and 5.56% in control). There was a significant difference in hospital admission (10.84% in the active group and 1.59% in control; p-value of 0.0078). At the end of the study, in the active group v control group, 92% v 52% of patients were on a beta-blocker, 92% v 48% on ACE-I/ARB, and 60% v 30% on an MRA. There were no differences in the final doses achieved.ConclusionsActive telemonitoring in an elderly population with systolic heart failure did not reduce cardiovascular mortality or admission to hospital for heart failure over the 1 year of the study. It did result in more patients receiving evidence based heart failure medications.Trial registrationThis trial received ethical approval from the Health Research Authority London-City Road and Hampstead Research Ethics Committee (REC Reference: 16/L0/0070, IRAS project ID: 173818). The ClinicalTrials.gov Identifier number is: NCT04371731. This trial was retrospectively registered on 30/4/2020 and this study adheres to CONSORT guidelines

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Abstract WP348: Blood Pressure Lowering in Patients With Intracerebral Haemorrhage: Data from the Ongoing Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage (TICH-2) Trial

Stroke ◽

10.1161/str.48.suppl_1.wp348 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Nikola Sprigg ◽

Katie Robson ◽

Zhe K Law ◽

Jason Appleton ◽

Philip Bath

Keyword(s):

Blood Pressure ◽

Functional Outcome ◽

Intracerebral Haemorrhage ◽

P Value ◽

Blood Pressure Lowering ◽

Serious Adverse Events ◽

P Values ◽

Pressure Lowering ◽

Baseline Characteristics ◽

The Relationship

Background: Intensive lowering of blood pressure in the hyperacute phase after intracerebral haemorrhage may improve outcome (as observed in the INTERACT-2 trial) or have no effect (ATACH-2). Clinical guidelines recommend BP lowering. Methods: We investigated the relationship between BP, and BP lowering treatment on functional outcome, death and serious adverse events at day 90. Statistical models were adjusted for baseline characteristics. Results: As at 18 th July 2016, 1161 (71.4%) of patients were on BP lowering treatment by day 2; these patients were younger (mean (SD): 67.7 (13.9) vs 71.9 (12.9) years, p-value<0.0001), more likely to be male (660/1161 (56.9%) vs 241/466 (51.7%), p-value=0.0598) and had lower NIHSS at baseline (12.5 (7.2) vs 14.2 (8.0), p-value<0.0001). Patients on BP lowering were found to have significantly better mRS and Barthel Index by day 90 (p-values: 0.0171, 0.0482, respectively) as compared to those not on treatment, and fewer of these patients died or suffered an SAE (p-values: 0.0074, 0.0002, respectively). However, there was no relationship between systolic BP levels (<140 vs >= 140 mmHg) on day 2, and outcome at day 90. Conclusion: Early BP lowering is associated with improved functional outcome, and fewer deaths and SAEs, at day 90. Those achieving a BP target of <140mmHg by day 2 did not have a better outcome, suggesting that the optimal BP target may need more investigation.

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Posterior Talofibular Ligament: The Relationship between its Length and Talar Morphometric Profiles

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00094 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0009

Author(s):

Chayanin Angthong ◽

Prasit Rajbhandari

Keyword(s):

Average Length ◽

Dome Height ◽

P Value ◽

Matched Pairs ◽

Talar Dome ◽

Body Width ◽

P Values ◽

Paired Samples ◽

The Relationship ◽

Posterior Talofibular Ligament

Category: Ankle, Sports Introduction/Purpose: Posterior talofibular ligament is one of the lateral ligamentous complex of the ankle. However, little is known about its anatomic profile especially on the relationship between its length and the morphometric profiles of talus. The present was to analyze the correlations between PTFL length and the talar morphometric profiles in the cadaveric specimens. The PTFL variation was also reported in this study. Methods: A total of twenty four cadaveric ankles as twelve matched pairs of ankle were collected in this study. All ankles were measured with a Vernier caliper which provided the data for further analysis regarding the PTFL length and the talar morphometric profiles. The data was calculated to demonstrate the relationship between PTFL length and the morphometric profiles of talus. There was a cadaveric ankle which was not used in the study due to its absence of PTFL. Results: An average length of PTFL was 23.9+/-6.9 mm. In overall, an average talar length (TaL) was 53.5 millimeters (mm). An average talar dome height (TaH) was 31.2 mm. An average talar body width (TaW) was 41.3 mm. The average anterior trochlear width (TrAW), middle trochlear width (TrMW), posterior trochlear width (TrPW), and trochlear length (TrL) were 31.8, 31.2, 28.3, and 30.7 mm. Based on twenty three ankles, the paired samples T-test showed the significantly negative correlations between PTFL length and TrL (Pearson’s r correlation coefficient: -0.432; P-value: 0.039). Other correlations were in negative values but P-values > 0.05. There were 16 ankles (84.2%) with 1 PTFL band and 3 ankles (15.8%) with 2 bands from 19 ankles with complete data. Conclusion: The present study may be a first study which delineates the relationship between PTFL length and the morphometric profiles of talus. The PTFL length was negatively correlated with talar size especially on the trochlear length of talus.

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Identification of the Country of Growth of Sophora flavescens using Direct Analysis in Real Time Mass Spectrometry (DART-MS)

Natural Product Communications ◽

10.1177/1934578x1400901116 ◽

2014 ◽

Vol 9 (11) ◽

pp. 1934578X1400901 ◽

Cited By ~ 1

Author(s):

Eriko Fukuda ◽

Yoshihiro Uesawa ◽

Masaki Baba ◽

Ryuichiro Suzuki ◽

Tatsuo Fukuda ◽

...

Keyword(s):

Mass Spectrometry ◽

Real Time ◽

Direct Analysis ◽

Absolute Difference ◽

P Value ◽

Sophora Flavescens ◽

P Values ◽

Chemical Fingerprinting ◽

The Difference ◽

The Relationship

In order to identify the country of growth of Sophora flavescens by chemical fingerprinting, extracts of plants grown in China and Japan were analyzed using direct analysis in real time mass spectrometry (DART)-MS. The peaks characteristic of each country of growth were statistically analyzed using a volcano plot to summarize the relationship between the p-values of a statistical test and the magnitude of the difference in the peak intensities of the samples in the groups. Peaks with a p value <0.05 in the t-test and a ≥2 absolute difference were defined as characteristic. Peaks characteristic of Chinese S. flavescens were found at m/z 439 and 440. In contrast, peaks characteristic of Japanese S. flavescens were found at m/z 313, 423, 437 and 441. The intensity of the selected peaks was similar in Japanese samples, whereas the m/z 439 peak had a significantly higher intensity than the other peaks in Chinese samples. Therefore, differences in selected peak patterns may allow identification of the country of growth of S. flavescens.

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